TY - JOUR
T1 - Incidence and outcomes of protamine reactions in patients undergoing catheter ablation of atrial fibrillation
AU - Chilukuri, Karuna
AU - Henrikson, Charles A.
AU - Dalal, Darshan
AU - Scherr, Daniel
AU - MacPherson, Edwin C.
AU - Cheng, Alan
AU - Spragg, David
AU - Nazarian, Saman
AU - Sinha, Sunil
AU - Berger, Ronald
AU - Marine, Joseph E.
AU - Calkins, Hugh
N1 - Funding Information:
Dr. Chilukuri was supported by The Norbert and Louise Grunwald Cardiac Arrhythmia Research Fund. Dr. Scherr was supported by the FWF—Austrian Science Fund. K.Chilukuri.C.A.Henrikson.D.Dalal.D.Scherr.
PY - 2009/9
Y1 - 2009/9
N2 - Background: Aggressive anticoagulation with heparin to maintain an activated clotting time (ACT) >300 s is required during catheter ablation of atrial fibrillation (AF) to reduce the risk of systemic thromboembolism. The purpose of this study is to describe the incidence and outcome of protamine reactions and analyze the risk factors in patients undergoing catheter ablation of AF. Methods: The patient population included 242 consecutive patients (193 men, age 57.6∈±∈10.8 years) with drug refractory AF who underwent catheter ablation and received protamine immediately following catheter ablation to reverse the effects of heparin. Fifty eight of these patients had prior exposure to protamine. Results: Three of the 242 patients in our study developed an adverse reaction to protamine (1.2%). Although each of the three protamine reaction presented in a dramatic fashion with profound hypotension, all three patients responded to medical treatment and did not experience clinical sequelae. Age, gender, type of AF, number of ablations, prior exposure, diabetes mellitus, and ejection fraction did not predict the occurrence of these reactions. Conclusion: This study reports, for the first time, the incidence and outcomes of protamine reaction in patients undergoing catheter ablation of AF. The results of this study reveal that protamine reactions present in a dramatic fashion often with profound hypotension. Although the incidence of protamine reactions in this setting is low (1.2%), they do occur. Electrophysiologists who use protamine need to be aware of this reaction and the appropriate therapeutic interventions.
AB - Background: Aggressive anticoagulation with heparin to maintain an activated clotting time (ACT) >300 s is required during catheter ablation of atrial fibrillation (AF) to reduce the risk of systemic thromboembolism. The purpose of this study is to describe the incidence and outcome of protamine reactions and analyze the risk factors in patients undergoing catheter ablation of AF. Methods: The patient population included 242 consecutive patients (193 men, age 57.6∈±∈10.8 years) with drug refractory AF who underwent catheter ablation and received protamine immediately following catheter ablation to reverse the effects of heparin. Fifty eight of these patients had prior exposure to protamine. Results: Three of the 242 patients in our study developed an adverse reaction to protamine (1.2%). Although each of the three protamine reaction presented in a dramatic fashion with profound hypotension, all three patients responded to medical treatment and did not experience clinical sequelae. Age, gender, type of AF, number of ablations, prior exposure, diabetes mellitus, and ejection fraction did not predict the occurrence of these reactions. Conclusion: This study reports, for the first time, the incidence and outcomes of protamine reaction in patients undergoing catheter ablation of AF. The results of this study reveal that protamine reactions present in a dramatic fashion often with profound hypotension. Although the incidence of protamine reactions in this setting is low (1.2%), they do occur. Electrophysiologists who use protamine need to be aware of this reaction and the appropriate therapeutic interventions.
KW - Adverse drug reaction
KW - Atrial fibrillation
KW - Catheter ablation
KW - Protamine
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U2 - 10.1007/s10840-009-9364-0
DO - 10.1007/s10840-009-9364-0
M3 - Article
C2 - 19263201
AN - SCOPUS:68749084679
SN - 1383-875X
VL - 25
SP - 175
EP - 181
JO - Journal of Interventional Cardiac Electrophysiology
JF - Journal of Interventional Cardiac Electrophysiology
IS - 3
ER -